Other specific DSP article suggested by Editorial Board
Development and Validation of a Nomogram for Predicting Multidrug- Resistant Pseudomonas Aeruginosa Pneumonia in Hospitalized Patients.
DOI: 10.2147/IDR.S527949
Authors: Du Z et al
Abstract
Objective: The management of multidrug-resistant Pseudomonas aeruginosa (MDR-PA) pneumonia remains challenging due to increasing antibiotic resistance and high mortality rates. Current prediction models often neglect three critical factors: comorbidities, medical interventions, and prior antibiotic exposure. This study created a practical risk assessment tool incorporating these clinical elements.
Methods: This retrospective study collected 3132 bronchoalveolar lavage fluid specimens from a large tertiary comprehensive hospital in southwestern China over a two-year period (20232024). A total of 209 patients with Pseudomonas aeruginosa pneumonia were ultimately enrolled, including 94 cases of multidrug-resistant and 115 drug-sensitive cases. Data included demographics, comorbidities, invasive procedures, antibiotic histories, and laboratory findings. Key predictors were selected using LASSO regression, followed by logistic regression to build a predictive model. Performance was evaluated through ROC analysis, calibration tests, and bootstrap validation.
Results: Thirteen predictors were identified: Age, prolonged hospitalization; Cor pulmonale, cardiac insufficiency, old cerebral infarction, chronic renal failure; ventilation, tracheostomy, nasogastric intubation; Cefoperazone-sulbactam, aminoglycosides, antifungals; Hemoglobin levels. The model showed strong predictive accuracy with AUC values of 0.853 (95% CI 0.793-0.914) in training and 0.972 (0.931-1.000) in validation cohorts. Calibration demonstrated excellent consistency (Hosmer-Lemeshow P=0.989).
Conclusion: In this study, a predictive model for MDR-PA pneumonia risk was developed and validated by integrating host comorbidities, iatrogenic interventions, and antimicrobial exposure. The model demonstrates potential utility in early identification of high-risk patients and may inform antimicrobial stewardship strategies in regions with predominant cephalosporin/aminoglycoside resistance patterns.
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Other specific DSP article suggested by Editorial Board
Inference of antimicrobial resistance (AMR) from a whole genome database outperforming AMR gene detection.
Authors: Cholsaktrakool P et al
Abstract
This study focuses on the rapid detection of antimicrobial resistance (AMR) in Klebsiella pneumoniae. The “Align-Search-Infer” pipeline aligned query sequences from 24 urine samples against a curated genome database of 40 Klebsiella isolates, searched for the best matches, and inferred their antimicrobial susceptibility. Carbapenem resistance inference achieved 77.3% accuracy (95%CI: 59.8-94.8%) within 10 min using whole-genome matching, and 85.7% accuracy (95%CI: 70.7-100.0%) within 1 h using plasmid matching – both surpassing the 54.2% accuracy (95%CI: 34.2-74.1%) of AMR gene detection at 6 h. The proposed method requires less bacterial DNA and is suitable for low-load clinical samples. Our small local database performed comparably to large public databases. This study supports the integration of pathogen-specific genome databases into clinical workflows to enable rapid and accurate antimicrobial susceptibility prediction. Further research is needed to validate and refine the method using larger genomic-phenotypic datasets across diverse pathogens and sample types.
Other specific DSP article suggested by Editorial Board
Does carbapenem resistance influence clinical outcomes in ICU patients with Klebsiella pneumoniae bacteraemia? A comparative analysis of Carbapenem-resistant and susceptible isolates.
Authors: Bhat D et al
Abstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a critical pathogen associated with high mortality in bloodstream infections, particularly in regions with high antimicrobial resistance. Aim of this study was to identify antimicrobial resistance patterns, clinical outcomes, and independent risk factors for mortality among patients with K. pneumoniae bacteraemia (KPB), comparing CRKP and carbapenem sensitive K. pneumoniae (CSKP) infections.
Methods: A retrospective observational study was conducted among adult ICU inpatients diagnosed with KPB between January to December 2023. Demographics, comorbidities, laboratory markers, treatment details, and clinical outcomes were matched between CRKP and CSKP groups. Univariate and multivariate logistic regression were used to identify independent predictors of mortality. Kaplan-Meier analysis was used to assess survival differences. All the analyses were performed using SPSS vs 20.0 software.
Results: Among 116 patients, 55.2% had CRKP bacteraemia. CRKP patients had old age (>65 years) and had higher rates of comorbidities including chronic liver (26.5%) and kidney disease (15.6%). Overall mortality rate was higher in CRKP patients (57.8%). Seven factors were independently associated with mortality: old age [OR:1.402(1.097-2.005)], chronic liver disease [OR:1.21(1.039-3.12)], chronic kidney disease [OR:2.30(1.277-6.098)]), prior carbapenem resistance [OR:1.369(1.037-3.66)], elevated CRP [OR:2.002(1.097-3.06)], vasopressor use within 48 hours [OR:1.332(1.007-2.148)] and early septic shock [OR:1.99(1.071-5.649)]. Kaplan-Meier survival curves showed higher early mortality in CRKP patients, suggesting that they died even before a conventional culture report was available.
Conclusion: Patients with CRKP bacteraemia showed significantly higher clinical severity and early mortality compared to those with CSKP infections. Rapid diagnostics, early appropriate empirical therapy in high-risk patients of CRKP and integrated stewardship strategies are critical for better outcomes. These findings offer actionable insights for risk stratification, diagnostic stewardship and timely intervention in high-burden settings.
Other specific DSP article suggested by Editorial Board
Candida tropicalis in the diabetic urinary tract: Biofilm resistance, genomic plasticity, and public health implications.
Authors: carpenter RE et al
Abstract
Fungal urinary tract infections (fUTIs) are emerging as a public health concern, notably in South Asia, where a convergence of ecological, genetic, and clinical factors underlies a rising burden of antifungal-resistant disease. This review synthesizes epidemiological, mechanistic, and genetic evidence implicating Candida tropicalis as a dominant uropathogen in South Asia’s diabetic and immunocompromised populations. A shift has been examined from Candida albicans to non-albicans Candida (NAC) species, driven by selective antifungal pressure and nosocomial transmission. Emphasis is placed on the virulence and adaptability of C. tropicalis, which forms biofilms, adapts metabolically under glycosuric and hypoxic conditions, and expresses antifungal resistance genes such as ERG11, CDR1, MDR1, and FKS1. Concurrently, South Asian host populations exhibit genetic variants-e.g., in TLR4, CLEC7A, CYP2C19-that impair fungal recognition, immune clearance, and antifungal pharmacokinetics, creating a syndemic landscape. The biofilm-mediated resistance mechanisms, epigenetic regulation of virulence genes, and the role of environmental sensing pathways in adaptive pathogenesis is presented in detail. Furthermore, the review delineates clinical challenges posed by biofilm-associated infections, delayed diagnostics, and resistance underestimation. Finally, a suite of public health and clinical recommendations-including biofilm-specific diagnostics, antifungal stewardship programs, pharmacogenomic screening, and national surveillance is proposed-to mitigate the escalating burden of drug-resistant candiduria. This integrative perspective bridges molecular pathogenesis and systems-level responses, offering a strategic roadmap for clinicians and policymakers to address C. tropicalis-driven fUTIs in South Asia and other high-risk regions.
Other specific DSP article suggested by Editorial Board
Wrong diagnosis – Wrong antimicrobials: Rise in antimicrobial resistance in developing countries. Prevalence of colistin resistance in multidrug-resistant Klebsiella pneumoniae recovered from clinical samples in Africa: a systematic review and meta-analysis.
Authors: Panda PK et al
Abstract
Antimicrobial resistance (AMR) is a growing global health crisis, disproportionately affecting developing countries. A key driver is the chain of wrong diagnosis leading to inappropriate antimicrobial use. Misclassification of infections-such as viral illnesses mistaken for bacterial infections-and failure to identify infection sources needing drainage or debridement result in unnecessary or ineffective antimicrobial therapy. This accelerates AMR, compels reliance on high-end antimicrobials, and fosters emergence of extensively drug-resistant pathogens. Compounding factors include sample contamination, absence of diagnostic-laboratory feedback loops, and empirical therapy without microbiological confirmation. Together, these perpetuate a vicious cycle of diagnostic error and AMR escalation. Strengthening diagnostic accuracy through point-of-care testing, molecular diagnostics, source control measures, and integration of diagnostic stewardship into antimicrobial stewardship programs is critical. Policy reforms, clinician education, and adoption of digital health innovations can support these efforts, breaking the cycle and preserving antimicrobial efficacy in resource-limited settings.
Other specific DSP article suggested by Editorial Board
Prevalence of colistin resistance in multidrug-resistant Klebsiella pneumoniae recovered from clinical samples in Africa: a systematic review and meta-analysis.
Authors: Gashaw Y et al
Abstract
Background: Colistin resistance in multidrug-resistant (MDR) Klebsiella pneumoniae is a growing concern in Africa, complicating treatment and public health management. Colistin is a last-resort antibiotic for Gram-negative infections, but its resistance in clinical settings presents significant challenges. This study aims to determine the pooled prevalence of colistin resistance in MDR K. pneumoniae isolates from clinical specimens in Africa.
Methods: Articles were sourced from PubMed, Scopus, ScienceDirect and Google Scholar. Studies included were those reporting colistin resistance in MDR K. pneumoniae from clinical specimens in Africa, using EUCAST and CLSI-standard drug susceptibility testing. Data were extracted into Excel and analysed using STATA 17 with a random-effects model to determine the pooled prevalence. Heterogeneity was assessed using the I 2 statistic, and publication bias was checked with Egger’s test. Subgroup analyses were performed to explore heterogeneity.
Results: The study analysed data from 30 articles on colistin resistance in MDR K. pneumoniae. The pooled prevalence was 21.59% (95% CI: 12.12-31.06), with high heterogeneity (I 2 = 99.71%). Sub-regional variation was significant (P < 0.001), with prevalence rates differing across regions: 42.34% in East Africa, 37.1% in West Africa, 17.1% in Southern Africa and 13.0% in North Africa. Country-specific rates were highest in Nigeria (39.12%), followed by Kenya (22.52%), South Africa (17.12%) and Egypt (14.0%) (P < 0.001).
Conclusions: Colistin resistance in MDR K. pneumoniae is high in Africa, with notable regional differences. The study calls for strict colistin regulations, robust antimicrobial stewardship and rapid diagnostic tools for resistance detection.
Other specific DSP article suggested by Editorial Board
Rapid detection of carbapenem resistance via MALDI-TOF MS using an innovative broth microgrowth assay
Authors: Xie, Z
Abstract
Objectives: Carbapenem-resistant Enterobacterales (CRE) are a growing threat to human health worldwide. This study aimed to develop a novel method, the broth microgrowth assay, for the rapid identification of CRE from culture isolates using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS).
Methods: A total of 80 isolates, including carbapenem-resistant Escherichia coli (CRECO, n = 28), carbapenem-sensitive Escherichia coli (CSECO, n = 28), carbapenem-resistant Klebsiella pneumoniae (CRKP, n = 12), and carbapenem-sensitive Klebsiella pneumoniae (CSKP, n = 12) were collected for this study. The minimum inhibitory concentrations (MICs) of imipenem and meropenem were measured for all the isolates via the broth microdilution method. Carbapenem resistance (R) and susceptibility (S) were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing, M100, 34th Edition. These isolates were incubated both with carbapenem antibiotics (imipenem and meropenem) as a detection site and without antibiotics as a growth control site at 35°C for 1 and 2 h, respectively. Following incubation, the mixtures were centrifuged, and the supernatant was pipetted off. The remaining sediment was subsequently applied to the MALDI-TOF MS target plate, and the residual broth was subsequently absorbed via sterile filter paper. Identification of the isolates was performed via the VITEK MS system. The test was deemed valid only if the sample without antibiotics (growth control) resulted in successful species identification (confidence level > 60.0%). Percentage of isolates that successfully grew without antibiotics and were identified by MALDI-TOF MS, which is referred to as the growth efficiency. CRE were distinguished if the microorganisms could be successfully identified.
Results: After 1 h of incubation with imipenem or meropenem, the growth efficiencies of E. coli and K. pneumoniae were 83.93% and 66.67%, respectively. For Escherichia coli, the sensitivity and specificity of imipenem resistance prediction by MALDI-TOF MS were 82.14% and 100%, respectively. Conversely, meropenem demonstrated a sensitivity of 89.29% and a specificity of 100%. When Klebsiella pneumoniae was examined, both imipenem and meropenem had sensitivity and specificity values of 83.33% and 100%, respectively. After the incubation time was extended to 2 h, both antibiotics achieved perfect sensitivity and specificity of 100%, coupled with a growth efficiency of 100% for both bacterial strains.
Conclusion: Combining the broth microgrowth assay with MALDI-TOF MS offers a rapid and accurate approach to identifying CRE, thus facilitating the swift selection of appropriate antibiotics.”
Other specific DSP article suggested by Editorial Board
A comparative study of the VITEK® REVEAL™ versus the VITEK2 system in susceptibility testing of NDM-producing enterobacterales and Acinetobacter baumannii directly from positive blood cultures
Authors: Shalom, O
Abstract
Purpose: To compare the antimicrobial susceptibility testing (AST) results obtained by the VITEK® REVEAL™ to the VITEK®2 system in the testing of (1) NDM-producing Enterobacterales (NDME) isolates and (2) NDM-producing Acinetobacter baumannii (NDMAb) isolates.
Methods: The study included 197 NDME isolates and 54 NDMAb isolates that were collected in Israel between 2018 and 2019. For the REVEAL™ testing, isolates were suspended in saline, inoculated into a blood culture FA Plus® bottles and incubated using the VIRTUO® system until flagged positive. A sample was then transferred into the REVEAL™ GN01 panel and the results were compared with the VITEK®2 N308 card as reference. Isolates with major or very-major discrepancies (MD and VMD, respectively) between the systems were tested by the Sensititre™ GNX3F Plates.
Results : For NDME, high rates of VMD were observed in amikacin (3.8%), imipenem (5.7%) and meropenem (8%) while high rates of MD were observed in trimethoprim-sulfamethoxazole (56.3%), amikacin (15.2%), and aztreonam (29%). Enterobacter cloacae isolates accounted for the majority of errors in carbapenem antimicrobials and aztreonam. Compared to the Sensititre results, REVEAL™ testing displayed lower agreement for ciprofloxacin (0/6) and aztreonam (5%) and higher agreement for trimethoprim-sulfamethoxazole (45%) and meropenem (87%). For NDMAb, there were 35% and 76% minor discrepancies in imipenem and meropenem, respectively. The REVEAL™ results matched the EtestTM method.
Conclusion: Use of the REVEAL™ system can provide rapid AST of positive blood culture. However, testing of NDME isolates revealed several discrepancies compared with the VITEKTM2 system. E. cloacae isolates accounted for the majority of the discrepancies.”
Other specific DSP article suggested by Editorial Board
Prevalence and risk factors of concurrent bacteremia in children under 5 years of age hospitalized with viral lower respiratory tract infections
Authors: Atay Ünal, N
Abstract
Purpose: We aimed to investigate the prevalence and risk factors of concurrent bacteremia in otherwise healthy children under 5 years of age hospitalized with PCR-confirmed viral lower respiratory tract infections (VLRTIs), and to assess the impact of the COVID-19 pandemic on its prevalence and etiology.
Methods: This retrospective study included children (≤ 5 years) hospitalized with PCR-confirmed VLRTIs between January 2018 and December 2024. Based on microbiology results obtained within 24 h of admission, we assessed the presence of concurrent, community-acquired bacteremia. Risk factors for bacteremia were evaluated using multivariate logistic regression.
Results: Among 1845 patients, concurrent bacteremia was identified in 36 (1.9%) patients with influenza- and respiratory syncytial virus (RSV)-associated LRTIs. Age ≤ 6 months [adjusted odds ratio (aOR) 14.6, 95% confidence interval (CI) 5.7–37.5], C-reactive protein (CRP) ≥ 4 mg/dL (aOR 3.9, 95% CI 1.5–9.8), fever (≥ 39 °C) (aOR 4.8, 95% CI 1.3–18.0), and the need for advanced respiratory support (aOR 8.3, 95% CI 3.0–23.2) were independently associated with an increased risk of bacteremia. In the post-pandemic period, a significant shift in pathogen distribution was observed, with gram-negative bacteria, particularly Klebsiella spp., emerging as the predominant cause of bacteremia.
Conclusion: Although rare, concurrent bacteremia was associated with high fever, elevated CRP levels, the need for advanced respiratory support, and an age of ≤ 6 months in children hospitalized with RSV and influenza associated LRTIs. Notably, gram-negative bacteria, particularly Klebsiella spp., emerged as predominant pathogens in the post-pandemic period, suggesting a potential shift in the epidemiology of bacteremia associated with VLRTIs.”
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Molecular investigation of unexpected Helicobacter pylori bacteremia
Authors: Perreau, C
Abstract
This study describes the isolation of Helicobacter pylori from a blood sample of an 88-year-old patient with no history or clinical signs suggestive of this infection. We summarize the microbiological characterization of the case, and the subsequent investigation using advanced next-generation sequencing methods, including a target enrichment technique adapted for paraffin-embedded gastric biopsy analysis.”